Addiction Counseling

Sound Familiar?

Erik had always been a hit in the party scene. The phrase “like a rockstar” had been used to refer to his approach to people, parties, and general all-around fun since college, where he was the president of his fraternity and an all-around popular guy. He’d always prided himself as a “work hard, play hard,” kind of guy, and since entering the work force 4 years ago, everyone knew him by this motto. However, over the past 2 years as his workload increased, this mantra didn’t seem to pay off as well. In fact, at a recent work event he got so drunk that he had to be driven home by a colleague, and was shocked to hear how inappropriate he’d been when he sobered up the next day — he didn’t remember any of it. The truth was, the older he got, the less cute his antics were, and people began to wonder whether he might have a problem.

Amanda was a hard-working, pre-med student, and even harder-working medical resident. Somewhere in college when she lost focus for a brief period, a friend suggested she might have ADHD and offered her a few of his prescription Adderall pills. They worked wonders, so she made a trip to a local psychiatrist known for handing meds out like candy. Now, some 4 years later, she was still taking them, and not as prescribed — she needed more than her prescribed dosage to function well at work with 12-hour shifts and seemingly endless demands for her attention and energy. She was well aware that this was a phenomenon known as “tolerance,” but didn’t know who to talk to about it without running the risk of putting her job in jeopardy.

Matthew had been a chubby child, and never quite recovered from the taunting and teasing he endured, even when he thinned out in high school and beyond. He was good-looking and popular as an adult, but always carried with him a bit of shame and insecurity as a result of those early experiences. Somewhere along the way in his pre-teen years, he discovered pornography on the internet. Though he was more than reluctant to admit it, the thrill of the “forbidden” coupled with the physical and emotional release he experienced when masturbating had become a powerful recipe for mitigating his negative emotions. Two months ago he’d been caught looking at hardcore pornography by his wife for the fourth time in their two-year marriage. He promised he’d stop looking, but knew he wasn’t any more likely to stop now than when he’d promised to stop the first time she caught him. The truth was, he’d tried to stop countless times throughout his adolescence, but just couldn’t do it. Was there a such thing as “pornography addiction”?

Addiction is real.

Although many people may view addiction as in issue of poor character, weak will, or moral failure, from a counseling perspective, addiction is a chronic, but treatable, brain disorder. In other words, addiction is a disease.

Though it often defies explanation, evidence seems to indicate that once a particular line has been crossed, otherwise talented, normal, and strong-willed people show remarkable difficulty to control their behavior around certain issues. In Western culture, the most popular areas of life that may lead to addictive behavior are in the areas of substances (drugs, alcohol), sex, gambling, and more. People may find that they are physically addicted (i.e., when the body has adapted its chemical state to crave or depend on the “highs” generated from certain activities) or psychologically addicted (i.e., when the mind develops similarly, with or without the physical side), and both are incredibly powerful. Some people mistakenly believe that psychological addiction is somehow less potent than the physical kind — they are wrong.

How to know if I need addiction counseling in Nashville.

With remarkable predictability, people suffering from addiction are caught in a cycle that takes the following stages:

Triggering: When a person struggling with an addiction encounters certain triggers — emotional, physical or otherwise — they have an impulse to “act out” in their particular addictive way. For example, an alcoholic may go to a restaurant with co-workers where they typically drink, and feel the urge to drink. A person struggling with sexual addiction may see a provocative image or feel anxiety, and feel compelled to masturbate or have sex. Whereas the non-addicted person will note these impulses, and then evaluate whether acting on them would be in their best interest, the truly addicted person has much less choice, and some very addicted persons effectively have no choice at all.

Craving: When cues (persons, places, things) get lodged in an addicted person’s mind, they begin to ruminate. Rumination in time gives way to the desire to fulfill the longing and thus experience relief from the rumination — this is known as craving. Craving is like experiencing muscle tension in your leg, and having a persistent, powerful urge to stretch your leg to gain some relief. But the problem is that this relief is often short-term — the urge eventually returns and begs to be fulfilled again. And again. The more people develop a cycle of craving and giving in, the more likely they are to develop a pattern of behavior around this tendency known as a ritual.

Ritualizing: Whereas people who keep the company of persons struggling with addiction (and often, addicts themselves) experience the addict’s behavior as chaotic or haphazard, the processes that enable addiction are remarkably straightforward and repetitive. In fact, they may become so repetitive that addicted persons develop rituals around them. For example, a person struggling with pornography addiction logs online benignly at first, and then begins an internet search for images, telling themselves they won’t access hardcore pornography. After a while, they give in to the urge to look at hardcore pornography, telling themselves they won’t masturbate. Eventually, they masturbate and then feel confused as to how they acted out again, when they just went to the internet to do something like check email. This happens with such utter frequency that it becomes a pattern or ritual, and it is followed each time, resulting in the addicted person’s acting out.

Acting Out: After passing through the above stages, sometimes with only a marginal level of awareness that they’ve done so, addicted persons “act out” or “use” – following the example above, eventually, the person who logged onto the internet benignly eventually masturbates while accessing hardcore pornography. They then feel confused as to how they acted out again, when they just went to the internet to do something like check email. As mentioned above, they do often experience relief (though long-term, chronic addicted persons may experience relief and secondary triggers/cravings almost instantaneously), followed by periods of shame, sadness, and guilt.

Guilt: Because addiction cycles are so often labeled as markers of poor character or moral failure, addicted persons often misbelieve that the most appropriate thing they can do after acting out is to heap piles of guilt on themselves, and friends and loved ones who are hurt by their actions are often all to eager to “help” them feel guilty. While no one would argue that injuring others is something anyone ought to feel “good” about, the truth is that feeling guilty is actually a part of the overall cycle, and addicts often mistake feeling badly as somehow helping them to be less likely to act out again in the future. This is the opposite of what generally occurs — feeling badly is often precisely the very thing (trigger) that leads an addict to begin looking for relief, thus starting the entire cycle all over again. In order to achieve lasting sobriety, intervening immediately after relapse and attempting to “short-circuit” guilt is the best starting point.

The devil is in the details.

One of the most confusing aspects of Nashville addiction counseling is the notion that addicted people are rarely the first to know they’re addicted. They may “act out” over and over again, seemingly confused by what’s transpiring, when it is painfully obvious to those around them that they are in fact addicted. Some people make external overtures toward acknowledging their addictions (“I know I can’t get enough sex!”), but when someone attempts to point out that they may have an addiction problem with seriousness, they are likely to be met with confusion, frustration, or even anger and rage. This is known as “denial,” and is in fact part of the disease of addiction. Persons in recovery often remark that “addiction is the only disease that claims you don’t have it.” This reality often leads to despair and outrage by those who are attempting to intervene in an addict’s life, including caregivers, friends, and family. It can be such a vexing phenomenon that loved ones become “co-dependent,” and spend a bulk of their time trying to get the addict to stop his or her addictive behavior. But again, denial is part of the problem, not somehow a separate component.

When is it time to get help for my addiction?

As noted above, addicted people and their families often encounter a dizzying amount of confusing, seemingly contradictory behavior, and don’t often know what really qualifies as addiction, and when it is time to get help. Here are some indicators that you or someone you know may need addiction counseling in Nashville:

Level of Interruption: It is often said that there is a fine line between addiction and run-of-the-mill behavior. The hallmark of addiction is often the level to which a person’s life is interrupted by their behavior. If you or a loved one find that your drinking, drug use, gambling, sexual behavior, etc. is causing problems with your job, school, relationships, or self, it is likely time to get help.

Level of intensity: When a behavior increases in frequency (how often), duration (how long) or intensity (to what extent), you’re likely addicted. For example, a person who drinks may need more to get drunk, more or more risky sex to achieve orgasm, or longer hours in the casino to get the “big win” (even when it never comes).

Level of withdrawal: When addicted persons can’t “scratch the itch” produced by craving, they may experience emotional, physical, or mental sensations as a result. For example, they may become angry, irritable, sad, etc. (emotional); Sweats, headaches, lack of appetite, etc. (physical); Difficulty concentrating, intrusive or interruptive thoughts, obsessive thinking, etc. (mental)

Level of control loss: Over time, repeatedly acting out leads to less and less ability to control behavior for addicted persons. They end up acting out for longer than they intended, in larger amounts, etc. Or, they may unsuccessfully try to temper their behavior — after each successive time acting out, they promise to taper off, cut back, or otherwise mitigate. Sometimes they have periods of relief, but it is followed by relapse, in spite of the fact they often sincerely wish to do otherwise.

Level of continuing use in spite of problems: The final and perhaps most disheartening indicator of addiction occurs when negative consequences come as a result of acting out — DUI’s or general legal trouble, fired from work, relationship problems or relationship termination, money loss, etc. — and the addicted person continues to engage in the addictive behavior anyhow.